Francesco/who-killed-jfk huggingface dataset:
[104-10222-10040.pdf — page 160]
14-000005FROMTOPLACE OF EMPLOYMENT (city and State)ERACT TITLE OF YOUR POSITIONSALARY / EARNINGSSTARTING $FINAL $PERPERNAME AND ADDRESS OF EMPLOYER (Arm, organization, oe person, if Federal, name department, bureau us establishment, and division)NAME AND TITLE OF IMMEDIATE SUPERVISORNUMBER AND KIND OF EMPLOYEES SUPERVISED BY YOUKIND OF BUSINESS OR ORGANIZATION (e. g. wholesale silk, Insurance agency, manufacture of books, etc)REASON FOR LEAVINGDESCRIPTION OF YOUR WORKIf more space is required, use a continuation sheet (Standard Form No. 56) or a sheet of paper the same size as this page. Write on each sheet your name, address, date of birth, and examination title. Attach to inside of this application.17. MILITARY TRAINING in the space below, describe any training received. In the Armed Services not already listed under Item 1s) that would assist aparitling officers in placing you must effectively. Indicate actual amount of training received, such as hours per week. Detailed information regarding any special service schools you attended is especially important (Extra pages may be used to give full descriptions)DATESFROMTOLOCATIONDESCRIPTION OF TRAININGJan 1944 May. 1944. Camp Callan, Calif.Basic anti-aircraft schooling in fire control, specialization in anti-armor. use of AA weapons.18 EDUCATION (Circle highest grade completed):1 2 3 4 5 6 7 8 9 10 11 12MARK (X) THE APPROPRIATE BOX TO INDICATE SATISFACTORY COMPLETION OFELEMENTARY SCHOOLADDED HIGH SCHOOLSENIOR HIGH SCHOOL(A) GIVE NAME AND LOCATION OF LAST HIGH SCHOOL ATTENDEDBath High School, Osborn, Ohio(B) SUBJECTS STUDIED IN HIGH SCHOOL WHICH APPLY TO POSITION DESIREDLanguages, History, Geography(1) NAME AND LOCATION OF COLLEGE OR UNIVERSITYMAJOR AND SPECIALTYDATES ATTENDEDYEARS COMPLETEDDEGREES CONFERREDFROMTODAYNIGHTTITLEDATESEMESTER HOURS CREDITThe Ohio State University.LA.Mar 1943 Sept 1943""LAMar-1945 Sept 1945-14University of ArizonaLASept1945 July 1947 24BAJuly 1947SpanishPolitical Science20 OTHER TRAINING (such as vocational business study classes, civilian defense courses, institute (Give name and location of school) OR SERVICE TRAINING IN PUBLIC OR PRIVATE EMPLOYMENTSUBJECTS STUDIEDDATES ATTENDEDYEARS COMPLETEDFROMTODAYNIGHT19 INDICATE YOUR KNOWLEDGE OF FOREIGN LANGUAGESREADINGSPEAKINGWRITINGIF YES, GIVE KIND OF LICENSE AND STATE22 ARE YOU NOW OR HAVE YOU EVER BEEN LICENSED OR CERTIFIED MEMBER OF ANY TRADE OR PROFESSION (such as pilot, electrician, radio operator, teacher, lawyer, CPA, etc)SpanishXXXYESNOGIVE KIND OF LICENSE AND STATEFrenchXLATEST LICENSE OR CERTIFICATE (YEAR)20 INDICATE YOUR KNOWLEDGE OF FOREIGN LANGUAGES (A) NAMES OF SOCIETIES AND ASSOCIATIONS (Include professional, scientific, business, civic, etc.) (B) NAMES OF ATHLETIC TEAMS, DRAMATIC CLUBS, ETC. (C) HOBBIES OR PASTIMES (D) MILITARY SERVICE, BUSINESS, ETC. (E) BOOKS, PUBLICATIONS, ETC21 LIST ANY ARTICLES YOU HAVE WRITTEN FOR PUBLICATION. ALSO LIST ANY PATENTS OR INVENTIONS. (GIVE PUBLISHER OR PATENT OFFICE, DATE OF PUBLICATION OR PATENT, ETC.)Phi Beta Kappa43-42594-4
[104-10222-10040.pdf — page 163]
14-00000②FROM Oct. 1949 TO Dec. 1951.PLACE OF EMPLOYMENT Washington, D.C. and Caracas, VenezuelaEXACT TITLE Assistant AttacheCLASSIFICATION GRADE FSS-9SALARY OR EARNINGS 4290 per yearNAME AND TITLE OF IMMEDIATE SUPERVISOR AmbassadorNAME AND ADDRESS Department of StateKIND OF ORGANIZATION GovernmentNUMBER AND KIND OF EMPLOYEES SUPERVISED BY YOU 3 clerksREASON FOR LEAVING Better opportunity in private industryDESCRIPTION OF YOUR WORK General duties of Foreign Service Staff Officer (Embassy - political section.) Preparation of reports for the Department and memoranda for the Ambassador. Consultation with officials of the local government and American companies (especially petroleum industry) operating in Venezuela. Assistance in visa affairs (consular section.)③DATES OF EMPLOYMENT Nov. 1947 TO Oct. 1949PLACE OF EMPLOYMENT Cincinnati, OhioEXACT TITLE EditorCLASSIFICATION GRADESALARY OR EARNINGS 3,600 per yearNAME AND TITLE OF IMMEDIATE SUPERVISOR Carl Frantz, ChiefNAME AND ADDRESS Procter and GambleKIND OF ORGANIZATION Soap and Chemical ManufactureNUMBER AND KIND OF EMPLOYEES SUPERVISED BY YOU 2 clerksREASON FOR LEAVING Desire to enter Foreign ServiceDESCRIPTION OF WORK Supervision of preparation (from compilation through printing) of sales manuals for company sales force. Preparation of aptitude tests and general qualifications questionnaires used by company in recruitment of salesmen. Preparation of material for company "house magazine." Liaison with other Personnel Departments. Close work with company printing plant and private establishments.4PLACE OF EMPLOYMENTNAME AND ADDRESSNUMBER AND KIND OF EMPLOYEES SUPERVISED BY YOUREASON FOR LEAVING
[104-10222-10040.pdf — page 166]
(CHANGES IN CIVILIAN PERSONNELWAR DEPARTMENTARMY AIR FORCES AT LARGE1. Name Robert T. Shaw2. Nature of Action Termination3. Effective Date August 6, 19429. Report Na T 42-306Patterson Field, Fairfield, O.August 6, 194210. Civil Service or other legal authority A.C.Cir. 40-811. Appropriation A.C.A. 1942-43 (C)|                    | FROM                              | TO    || ------------------ | --------------------------------- | ----- || 4. Position        | Asst. Messenger, CU-2             |       || 5. Salary          | $1080 per annum                   |       || 6. Org'a Unit      | Air Service Command               |       || 7. Headquarters    | Patterson Field, Fairfield, Chio. |       || 8. Dupt'l or Field | FIELD                             | FIELD |12. Date of birth June 18, 192513. Legal Residence Ohio14. Subject to Retirement Act? No15. Oath Taken16. Remarks By resignation (Vol.) due to ill health.Civideo alitiority Letter of ResignationUnder authority delegated by the Secretary of War in Orders N, dated December 23, 1941. and the directive of the Chief of the Air Corps dated January 17, 1942, you are notified of the above action concerning your employment.![signature of CHARES Shiny]
[104-10222-10040.pdf — page 167]
# WAR DEPARTMENTOFFICE OF THE SECRETARYNOTIFICATION OF PERSONNEL ACTIONOffice: Wright Field, ChioDate: August 4, 1942Name: BORAT T. BHAWjfw/bltJournal No: 18-55285-42Nature of Action: Confirmation of War Borvice Appointeant (Teaporary)Effective Date: June 8, 1'!|                       | From  | To                        || --------------------- | ----- | ------------------------- || Position              |       | Asaistunt Nessenger.....  || Grade & Salary        |       | CU-2 at $1000 par annua   || Bureau                |       | Army Air Forces           || Org. Unit             |       | Air Servi o Command       || Station               |       | Fairfield Air Depot, Chio || Departmental or Field | FIELD | FIELD                     |Civil Service or other Legal AuthorityW. F. 8. R. L-CSC5/85/42AppropriationRegularDate of Birth6/10/25NATURE OF POSITIONNEW ADDNL. INDEXXVICE VACANCYRemarks: Aposintownt a woder das Cervica za ulatin Va, servion. 1716 downfernal dan termice sta上好き。لتاليةade for 90 daga,By order of the Secretary of WarJohust. MartynAdministrative AasishinC S. C. REPORT (Form 50)TEMPORARY SERIES, DISTRICT MANAGER - PERMANENT SERIES, C. S. COMMISSIONCode-21
[104-10222-10040.pdf — page 168]
(Form LE-100)BOARD OF U. S. CIVIL SERVICE EXAMINERSWRIGHT FIELD - FAIRFIELD AIR DEPOTGARFIELD BUILDING, 4TH AND JEFFERSON STS.,DAYTON, OHIOPIH/cbSixth CIVIL SERVICE DISTRICTJune 26, 1942(Date)THE COMMISSIONAttention: Service Record DivisionThe following appointment has been authorized underExecutive Order No. 9063 through competitive examination.Shaw, Robert T.Assistant Messenger, Cu-2, $1030 per annum(Position and Salary)War Department, Army Air Forces(Department or Agency)Patterson Field, Fairfield, Ohio(Location)![signature of James W. Hanley]JAMES W. HANLEY, SecretaryBoard of U. S. Civil Service Examiners
[104-10222-10041.pdf — page 0]
2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992SECRETFILE TITLE/NUMBER/VOLUME: Corsin, LusinINCLUSIVE DATES: 11 Dec 53 - 13 Jan 76CUSTODIAL UNIT/LOCATION: OPROOM: 5E13DELETIONS, IF ANY:| DATE RECEIVED | DATE RETURNED | REVIEWED BY (PRINT NAME) | SIGNATURE OF REVIEWING OFFICIAL || ------------- | ------------- | ------------------------ | ------------------------------- ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 ||               |               |                          |                                 |NO DOCUMENTS MAY BE COPIED OR REMOVED FROM THIS FILESECRETKRATH, Arthur R.
[104-10222-10041.pdf — page 1]
# Contract Service - Arthur R. Schfickrath (P)| Date | Action | Compensation Equivalent || ---- | ------ | ----------------------- |Former Military Detailed to Agency.Retired Reserve officer12 Nov 61 | Hired as a Career Agent with Civil || Service Retirement, LPAs and PSIs | 11,415 GS-13/414 Oct 62 | LPA | 12,245 GS:-13/428 AM 63 | Pay increase | 13,270 G5-14/25 Jan 64 | LPA | 14,065 GS-14/226 AM 64 | PSI | 14.515 6514/35 July 64 | LPA | 15,150 65-14/325 AM 64 | PSI | 15,640 65-14/410 Oct 65 | LPA | 16,204. GS.14/43 July 66 | LPA | 16,675 6544/48 Oct 67 | LPA | 17,425 65-14/49-Jan 20 | Contract Terminated | 17.425. GS-14/410 Jun 68 | Contract Employee with Civil Service Retirement, LPAs and PSIs | 17,425 6514/414 Jul 68 | LPA | 18.691 61-14/415 Jul 68 | Contract Terminated | 18,641 6514/4
[104-10222-10041.pdf — page 2]
CLUIILISHINICKRATH, ARTHURRJobs 69 731 Follo13 JANCI 055-76MEMORANDUM FOR: Director of PersonnelSUBJECT : Compromise of Cover1.  As a result of information obtained from reliable sources who served in Vietnam, we have established that the former Staff personnel listed on the attachment should be presumed to have been compromised as CIA employees to the North Vietnam Intelligence Service as of April 1975. We presume also that the identifications of these individuals as CIA employees were passed by the North Vietnamese to the Soviets.2.  Although the personnel listed in the attachment are no longer employed by CIA, nevertheless, I suggest that their official personnel records should be documented concerning the possible past compromise of their cover.3.  Please coordinate any action connected with this memorandum with Chief, CCS; Chief, CMG; and Chief, CI Staff.![signature of George T. Kalaris]George T. KalarisChiefCounterintelligence StaffAttachment: a/sSECRET
[104-10222-10041.pdf — page 3]
25 January 1974Drug Enforcement AgencyOffice of PersonnelTechnical Support Section1405 I Street, N. W.Washington, D. C. 20537Attention: Ms. Mary ElliottDear Ms. Elliott:In response to the request from your office of 16 January, the following is a transcript of the employment of LUCIEN E. CONEIN:| Date       | Action                                                                                                   | Salary                || ---------- | -------------------------------------------------------------------------------------------------------- | --------------------- || 12 Nov 61  | Contract Employee with Civil Service Retirement, Legislative Pay Adjustments and Periodic Step Increases | $11,415 (GS-13/4 eq.) || 14 Oct 62  | Legislative Pay Adjustment                                                                               | $12,245 (GS-13/4 eq.) || 28 Apr 63  | Pay Increase                                                                                             | $13,270 (GS-14/2 eq.) || 5 Jan 64   | Legislative Pay Adjustment                                                                               | $14,065 (GS-14/2 eq.) || 26 Apr 64  | Periodic Step Increase                                                                                   | $14,515 (GS-14/3 eq.) || 5 July 64  | Legislative Pay Adjustment                                                                               | $15,150 (GS-11/3 eq.) || 25 Apr 64  | Periodic Step Increase                                                                                   | $15,640 (GS-14/4 eq.) || 19 Oct 65  | Legislative Pay Adjustment                                                                               | $16,204 (GS-11/4 eq.) || 3 July 66  | Legislative Pay Adjustment                                                                               | $15,675 (GS-14/4 eq.) || 8 Oct 67   | Legislative Pay Adjustment                                                                               | $17,425 (GS-14/4 eq.) || 14 July 68 | Legislative Pay Adjustment                                                                               | $18,641 (GS-14/4 eq.) || 15 July 68 | Contract Terminated                                                                                      | $18,641 (CS-14/4 eq.) |Attached is Standard Forms 175 and 1130, There is no record of Standard Forms 2809 and 2810. Perhaps his military retirement obliviated the need for health insurance.Sincerely,Roger FowlerPersonnel OfficerAttachments
[104-10222-10041.pdf — page 4]
UNITED STATES DEPARTMENT OF JUSTICEDRUG ENFORCEMENT ADMINISTRATIONWashington, D.C. 20537Jan. 16, 1974Mr. John F. BlakeDirector of PersonnelCentral Intelligence AgencyWashington, D.C. 20505Re: Lucien E. Conein, SSN: 513-05-0926DOB: 11-29-19Dear Mr. Blake:An official transcript of service is requested for Mr. Conein, an employee with this agency. Mr. Conein was employed with your agency from November 12, 1961 to July 15, 1968. Request Standard Form 176, 1150, 2509 and 2810 be forwarded to Drug Enforcement Administration, Office of Personnel, Technical Support Section,Att: Mary Elliott, 1405 I Street, N.W., Washington, D.C. 20537.Enclosed is a Standard Form 50 showing Mr. Conein's employment with this Agency.Thank you for your cooperation in this matter.Sincerely yours,![signature]Personnel DirectorEnclosureAS
[104-10222-10041.pdf — page 5]
# NOTIFICATION OF PERSONNEL ACTION![United States Department]1 NAME IS APS LAST FIRSTCONEIN LUCIEN EMILEMR5 VETERAN PREFFOFTE1 NO4 10 PI CON2 SP3 10 PI DISABILITY5 10 PI OTHER6 TENURE GROUP7 SERVICE COMP DATE8 HANDICAP CODE9 REGLI DEG CHAY 34WD 4 REG & OP 10 RETIREMENT12 NATURE OF ACTION1- CS2 FICA3 FS4 NONE11 (F...CSC use)14 CIVIL SERVICE OD OTHER LEGAL AUTHORIN13 EFFECTIVE DATE15 FROM:POSITION TITLEAND NUMBER16 PAY PLAN APA)OCCUPATION CODE17 GRADEOP LEVELAND RATE18 SALARY19 NAME ANDLOCATION OFEMPIOVINGOFFICE20 TO:POSITION TITLEAND NUMBER21 PAY PLAN APA)OCCUPATION CODE22 GRADEOP LEVELAND RATE23 SALARY24 NAME ANDLOCATION OFJAPLOVINGOFFICE25 GANY SIA26 LOCATION CODE27 APPROATION28 POSITION OCCUPIED29 APPROATION USE1 PREVIO2 WAIVEDTRANSCRIPTPlease Forward Official FerconneEasier and S.F. 1150 to:DPUR AdministrationPersonnel Management Division1405 I Street, N.a.Architien, D.C. 20037ATT MARY ELLIOTT ROOM 801
[104-10222-10041.pdf — page 6]
9 OCT 1973Mr. James BallardActing Director of PersonnelDrug Enforcement Agency1405 I Street, N. W.Washington, D. C. 20537Dear Mr. Ballard:This is to certify that Mr. Lucion E. Conoin was employed by this Agency in a civilian capacity from 12 November 1961 to 15 July 1968, at which time ho rotired on disability under the Civil Service Rotiroment Act. He left under honorable circumstances.Sincerely,John F. BlakeDirector of PersonnelDistribution:041 - Addresseo1 - D/Pers1 - FFAB Subject File1 - FEAD ChronoOP/RAD/ELAB/FGJarema:kr (4 October 1973j
[104-10222-10041.pdf — page 7]
SENDER WILL CHELUNCLASSIFIED CONFIDENTIAL SECRETOFFICIAL ROUTING SLIPTONAME AND ADDRESSDATEINITIALS1.  C/RAD2. 3. 4. 5. 6. ACTIONAPPROVALCOMMENTCONCURRENCEDIRECT REPLYDISPATCHFILEINFORMATIONPREPARE REPLYRECOMMENDATIONRETURNSIGNATURERemarks:I Hes word like you to grarts senice. Ha in obviously har mre Tume than wiccatoo! wily await une certifying the de of it. Ars une avare of what be har too DEA?FOLD HERE TO RETURN TO SENDERFROMNAME A PERSS ANG PIKALA NODATE02 OCT 1973FORM NGUNCLASSIFIED CONFIDENTIALSECRET1.57 237---SENOFF WILL C...CAUNCLASSIFIED CONFIDENTIAL SECRETOFFICIAL ROUTING SLIPTONAME AND ADDRESSDATEINITIALS1.  C/RAD2. 3. DD/Pcs/SP   05 OCT 19734. D/Pers-   145. See Daze's note and attactal6. ACTIONAPPROVALCOMMENTCONCURRENCEDIRECT REPLYDISPATCHFILEINFORMATIONPREPARE REPLYRECOMMENDATIONRETURNSIGNATURERemarks:Ben- A Hached is one rewrite of the Concin menu. Also an explanatory note se his prive dinvece.FOLD HERE TO RETURN TO SENDERFROMNAME C/EEAB 202 Magazine x3295DATEUNCLASSIFIED CONFIDENTIAL SECRETFORM NG237
[104-10222-10041.pdf — page 8]
4 October 1973Ron -Conein was in U.S. military from September 1941 through September 1961, and on detail to OSS, SSU, CIG, and CIA to time of military retirement.He was picked up as a civilian and as a career agent on 12 November 1961 and retired on disability on 15 July 1968.Archenhold advised that subject claims military service as indicated above and that the only period to be certified is the period as a civilian, November '61 to July '62. This all we know about what Conein told DEA.Frank C. JaremaDistribution:0 - C/RAD1 - EEAB Memos file1 - EEAB ChronoOP/RAD/EEAB/FGjarema:pig (4 October 1973)
[104-10222-10041.pdf — page 9]
Mr Janney 1 OCT 1973Mr BlakeBecause of the publicity this man has recieved I suggest you touch base on the phone with Howard Osborn. RDKVerify service +unter te hos ForlDEA| SENDER WILL CHF | CLASSIFICATION TOP AND BOTTOM || --------------- | ----------------------------- || UNCLASSIFIED    | CONFIDENTIAL SECRET           |## OFFICIAL ROUTING SLIP| TO  | NAME AND ADDRESS | DATE        | INITIALS || --- | ---------------- | ----------- | -------- || 1   | DD/Pers/SP       | 01 OCT 1973 |          || 2   | D/Pers           |             |          || 3   |                  |             |          || 4   |                  |             |          || 5   |                  |             |          || 6   |                  |             |          || ACTION      | DIRECT REPLY | PREPARE REPLY  || ----------- | ------------ | -------------- || APPROVAL    | DISPATCH     | RECOMMENDATION || COMMENT     | FILE         | RETURN         || CONCURRENCE | INFORMATION  | SIGNATURE      |Remarks: Luke Conein has applied for employment with the Drug Enforcement Agency. The Acting D/Pers asked for the attached info from CIA.Sent to D/Pers for signature. Conein was very controversial, much in the news about the overthrow of Ngo Dinh Diem and has been mentioned by Howard Hunt in Hunt's recent hearing before "Watergate" committee. Dick Biladeau, Central Cover, affirms that Conein is "opened up".RGC/RAD, 212 Magazine Bldg. x3328 9/23/73
[104-10222-10041.pdf — page 10]
Ben -28 September 1973Stan Archenhold, x 7264, one of the Agency's drug coordinators with DEA, called me yesterday afternoon. DEA had requested a memo verifying employment of Mr. Lucien E. Conein, whose name has appeared frequently during the Watergate hearings. The attached memorandum is what Archenhold wants.Conein's service was verified with ROB; his "honorable service" was cleared with SAS. Since he was under cover as contract, I discussed the case with Dick Biladeau of Central Cover. CCS had opened up Conein last year and Biladeau approved release of the information to DEA. We had verified this service to a Justice Department investigator approximately one year ago when Conein was being considered as a consultant for BNDD.Archenhold offered to carry the memorandum to DEA.![signature of Frank G. Jarema]Frank G. Jarema
[104-10222-10041.pdf — page 11]
#4 DATE AND NATURE OF SEPARATION## SUMMARY OF ANNUAL AND SICK LEAVE3. Balance from prior leave year ended5 Current leave year accrual through7 Total8 Reduction in credit, if any (current year)9 Total leave taken10 Balance11 Total hours paid in lump sum12 Salary rate(s)13 Lump sum leave dates:from 1500 7/15/68 to 9/17/6826 Certified correct by:AUTH. CERT. OFFICERStandard Form 1150November 19631110-106ITENDARITY 1500 7/15/68(HOURS)1/137/13360 hr plus 1 Holiday18,6411500(Hours)(Signature)(Title)INITIALS APPOINTMENT DATASubject to Sec. 203(d) 1951 Leave ActCeased to be subject to Sec. 203(d)Annual Leave## SUMMARY OF HOME LEAVE(DAYS)14 Date arrival abroad for HR purposes15 Current balance as of16 12 month accrual rate 15 days17 Dates leave used, prior 24 months18 Monthly accrual date19 Calendar days credit for next accrual date20 Date basic service period completed### MILITARY LEAVE21 Dates during current calendar yr22 Dates during preceding calendar yr### ABSENCE WITHOUT PAY23 During leave year in which separated24 During step increase waitingperiod which began on25 During 12 month HR accrual period (dates)TOTAL SERVICE FOR LEAVE(as of date of separation)More than 13 yearsREMARKS7/29/65 SCD 11/2/417/29/67AWOP or AWOL orFurlough Suspension(Hours)US. CIVIL SERVICE COMMISSIONFPM SUPPLEMENTS 296-31 AND 990-2RECORD OF LEAVE DATA TRANSFERRED|     | Annual | Sick || --- | ------ | ---- ||     | 360    | 210  ||     | 104    | 52   ||     | 464    | 262  ||     | 0      | 0    ||     | 104    | 262  ||     | 360    | 0    ||     |        |      ||     |        |      ||     |        |      ||     |        |      |
[104-10222-10041.pdf — page 12]
# ELECTION, DECLARATION, OR WAIVER OF LIFE INSURANCE COVERAGEFEDERAL EMPLOYEES GROUP LIFE INSURANCE PROGRAMTO COMPLETE THIS FORMFOLLOW THESE GENERAL INSTRUCTIONS:*   Read the back of the "Duplicate" carefully before you fill in the form.*   Fill in BOTH COPIES of the form. Type or use ink.*   Do not detach any part.FILL IN THE IDENTIFYING INFORMATION BELOW (please print or type):NAME (last) (first) (middle) DATE OF BIRTH (month, day, year) SOCIAL SECURITY NUMBEREMPLOYING DEPARTMENT OR AGENCY LOCATION (City, State, ZIP Code)MARK AN "X" IN ONE OF THE BOXES BELOW (do NOT mark more than one):Mark here if you WANT BOTH optional and regular insurance(A) ELECTION OF OPTIONAL (IN ADDITION TO REGULAR) INSURANCEI elect the $10,000 additional optional insurance and authorize the required deductions from my salary, compensation, or annuity to pay the full cost of the optional insurance. This optional insurance is in addition to my regular insurance.This optional insurance is in addition to my regular insurance.Mark here if you DO NOT WANT CITIONAL but do want regular insurance(B) DECLINATION OF OPTIONAL (BUT NOT REGULAR) INSURANCEI decline the $10,000 additional optional insurance. I understand that I cannot elect op-tional insurance until at least 1 year after the effective date of this declination and unless at the time I apply for it I am under age 50 and present satisfactory medical evidence of insurability. I understand also that my regular insurance is not affected by this declination of additional optional insurance.Mark here if you WANT NEITHER regular nor optional insurance(C) WAIVER OF LIFE INSURANCE COVERAGEI desire not to be insured and I waive coverage under the Federal Employees Group Life Insurance Program. I understand that I cannot cancel this waiver and obtain regular in-surance until at least 1 year after the effective date of this waiver and unless at the time I apply for insurance I am under age 50 and present satisfactory medical evidence of insurability: I understand also that I cannot now or later have the $10,000 additional optional insurance unless I have the regular insurance.SIGN AND DATE. IF YOU MARKED BOX "A" OR "C", COMPLETE THE "STATISTICAL STUB." THEN RETURN THE ENTIRE FORM TO YOUR EMPLOYING OFFICE.SIGNATURE (do not print)DATEFOR EMPLOYING OFFICE USE ONLY(official receiving date stamp)ORIGINAL COPY-Retain in Official Personnel FolderSee Table of Effective Dates on back of OriginalFINAL FORM 176-7APR 14 1960